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Basal metabolic rate in children with a solid tumour
E den Broeder1, B Oeseburg, R J Lippens
1Department of Paediatrics, University Hospital Nijmegen, The Netherlands. edenbroeder@hotmail.com
Insights
Children with solid tumors have elevated basal metabolic rates (BMR) at diagnosis, impacting energy needs for nutritional support. BMR decreases during treatment, correlating with tumor response.
Area of Science:
- Pediatric Oncology
- Metabolic Research
- Clinical Nutrition
Background:
- Children with solid tumors often require specialized nutritional support.
- Accurate estimation of energy expenditure is crucial for effective nutritional management in pediatric oncology patients.
Purpose of the Study:
- To investigate basal metabolic rate (BMR) levels and changes in children diagnosed with solid tumors.
- To determine if BMR alterations during treatment necessitate adjustments in energy requirements for nutritional support.
Main Methods:
- Observational study conducted at a tertiary care pediatric oncology center.
- Basal metabolic rate (BMR) measured via indirect calorimetry in 13 children with solid tumors.
- BMR assessed at diagnosis and during treatment, compared against Schofield reference values.
Main Results:
- All patients exhibited a higher BMR at diagnosis, with 44% classified as hypermetabolic.
- Mean BMR significantly increased at diagnosis (11.6%) but decreased during treatment (12.7%).
- A negative correlation was observed between changes in BMR and tumor response (P=0.01).
Conclusions:
- Children with solid tumors present with elevated BMR at diagnosis and potentially during early treatment phases.
- These findings highlight the importance of monitoring BMR for accurate energy requirement assessment in pediatric oncology.
- Dynamic BMR changes during treatment may influence nutritional support strategies.
Objective:
To study the level of and changes in basal metabolic rate (BMR) in children with a solid tumour at diagnosis and during treatment in order to provide a more accurate estimate of energy requirements for nutritional support.
Design:
An observational study.
Setting:
Tertiary care at the Centre for Paediatric Oncology, University Hospital Nijmegen.
Subjects:
Thirteen patients were recruited from a population of patients visiting the University Hospital Nijmegen for treatment. All patients asked to participate took part in and completed the study.
Intervention:
BMR was measured by indirect calorimetry, under stringent, standardised conditions, for 20 min and on three different occasions in all patients. Continuous breath gas analysis using a mouthpiece was performed. Weight, height and skinfold measurements were performed before each measurement.
Main Outcome Measures:
BMR was expressed as percentage of the estimated reference value, according to the Schofield formulas based on age, weight and sex, and in kJ (kcal) per kg of fat-free mass.
Results:
At diagnosis, the BMR was higher than the estimated reference BMR in all patients and 44% of the patients were considered hypermetabolic. Mean BMR (as percentage of reference) was significantly increased (11.6% (s.d. 6.7%); P=0.001), but decreased during treatment in 12 of the 13 patients (mean decrease 12.7% (s.d. 3.9%); P<0.0001). Furthermore, a significant negative correlation (P=-0.67; P=0.01) was found between the change in BMR and tumour response.
Conclusions:
These data suggest that the BMR of children with a solid tumour is increased at diagnosis and possibly during the first phase of oncologic treatment. This may be important when determining energy requirements for nutritional support.
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